Transurethral bladder neck incision in bladder neck dyssynergia

Abstract

7 male patients with dyssynergic bladder neck obstruction were evaluated. Di¬agnosis of bladder outlet obstruction with obstructive as well as irritative symp¬toms was done by urodynamic studies, and once obstruction was diagnosed it was localized at the level of the bladder neck by voiding cystourethrography and trans-rectal voiding ultrasonography. In all patients definitive relief was achieved by transurethral bladder neck incision. Complete resolution of their obstructive and irritative voiding symptomatologies were obtained within 3 months of surgery. Pressure-flow studies revealed that peak and mean urinary flow rates increased from average values of 13 and 4.8 ml per second upto 32.4 and 14 ml per second, respectively, and associated average intravesical voiding pressure decreased from 127.2 cm of water preoperatively to 45.4 cm of water postoperatively. Post-voiding redual urine diminished to reasonable volumes. These results indicate that dyssyn¬ergic bladder neck obstruction is definitively and reliably treated by incising the bladder neck full thickness in carefully selected patients.